Customer Name
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Phone Number
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Email
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example@example.com
Street Address
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Unit Number
Zip Code
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City
Select Program of Interest
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Home Energy & Water Upgrade Program
How did you hear about us?
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City Referral
Email
Flyer
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Property Management
Owner
Glendale Water & Power Customer
Other
Best Time to Call
AM
PM
Monday
Tuesday
Wednesday
Thursday
Friday
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